Effect of end-inspiratory pause duration on respiratory system compliance calculation in mechanically ventilated dogs with healthy lungs.

OBJECTIVE: To compare respiratory system compliance (CRS), expressed per kilogram of bodyweight (CRSBW), calculated without end-inspiratory pause (EIP) and after three EIP times (0.2, 0.5 and 1 seconds) with that after 3 second EIP (considered the reference EIP for static CRS) and to determine the EIP times that provided CRSBW values in acceptable agreement with static CRSBW during controlled mechanical ventilation (CMV) in anaesthetized dogs. STUDY DESIGN: Prospective, randomized, nonblinded, crossover clinical study. ANIMALS: A group of 24 client-owned dogs with healthy lungs undergoing surgery in lateral recumbency. METHODS: During CMV in dogs undergoing general anaesthesia, five EIPs [0 (no EIP), 0.2, 0.5, 1 and 3 seconds] were consecutively applied in random order. Tidal volume (Vt) was set at 10 mL kg-1 and positive end-expiratory pressure (PEEP) was not applied. Respiratory rate and inspiratory time were established according to each EIP time, setting EIP between 0 and 50% of the inspiratory time. The CRSBW was calculated as [expired Vt/(plateau pressure - PEEP)]/bodyweight and recorded every 15 seconds for 2 minutes after a 5 minute equilibration period with each EIP. One-way anova for repeated measures and the Bland-Altman analysis were used to compare CRSBW and evaluate agreement between EIP times, respectively. RESULTS: The CRSBW was significantly greater as the EIP time increased up to 1 second (p < 0.05). In the Bland-Altman analysis, none of the tested EIPs (0, 0.2, 0.5 and 1 seconds) provided 95% confidence intervals for limits of agreement within the maximum allowed difference considered for acceptable agreement with 3 second EIP. CONCLUSIONS: and clinical relevance An EIP ≤ to 1 second does not provide a CRSBW value in acceptable agreement with static CRSBW in healthy dogs. Besides, the application of an EIP ≤ to 0.5 seconds underestimates the static CRSBW to an increasing extent as the EIP time decreases.

Comunidades Compasivas: intervención comunitaria para la preven-ción del duelo complicado. Modelo implantado por Madrid Salud / Compassionate Communities: Community intervention for the prevention of complicated grief. Model implemented by Madrid Salud

Objetivo: Fortalecer la capacidad de las personas para afrontar y acompañar las situaciones de duelo desde el modelo de Comunidades Compasivas a través de una perspectiva comunitaria. Metodología: Diseño de dos ejes de intervención: sensibilización y formación a la población y profesionales, y desarrollo de espacios grupales dirigidos a prevenir el duelo complicado. Resultado: Se ha realizado un diagnóstico de la ciudad de Madrid. Se han realizado 60 formaciones dirigidas al personal de Madrid Salud y 32 a profesionales entidades del entorno comunitario. Se han realizado 327 sensibilizaciones en torno al final de la vida y el duelo (5.873 personas). Se ha establecido contacto con 283 recursos públicos y 158 recursos privados a lo largo del año. Por último, se han llevado a cabo un total de 15 Espacios Grupales de Acompañamiento al Duelo. Conclusiones: El modelo de comunidades compasivas de la ciudad de Madrid ha conseguido fortalecer las capacidades de la ciudadanía de Madrid para el cuidado colectivo a través de las diferentes actividades de sensibilización e impactar en el fortalecimiento profesional y sensibilidad de los profesionales de la salud en relación con los conceptos clave del proyecto, generando así una comunidad compasiva (AU)

Objective:The main objective of the Compassionate Communities project in the city of Madrid is to strengthen people’s ability to face and accompany grief situations through a community perspective. Methodology: Design of two intervention axes: sensitization and training of the population and professionals, and development of group spaces aimed at preventing complicated grief. Result: A diagnosis of the city of Madrid has been carried out. Sixty trainings have been carried out for Madrid Salud staff and 32 for professionals and community organizations. There have been 327 sensitizations about the end of life and bereavement (5,873 people). Contact was established with 283 public resources and 158 private resources throughout the year. Finally, a total of 15 Group Spaces for Grieving Support have been carried out. Conclusions: The compassionate communities model of the city of Madrid has managed to strengthen the capacities of the citizens of Madrid for collective care through the different awareness-raising activities and to impact on the professional strengthening and sensitivity of health professionals in relation to the key concepts of the project, thus generating a compassionate community (AU)

Individualized positive end-expiratory pressure following alveolar recruitment manoeuvres in lung-healthy anaesthetized dogs: a randomized clinical trial on early postoperative arterial oxygenation.

OBJECTIVE: To assess and compare the effect of intraoperative stepwise alveolar recruitment manoeuvres (ARMs), followed by individualized positive end-expiratory pressure (PEEP), defined as PEEP at maximal respiratory system compliance + 2 cmH2O (PEEPmaxCrs+2), with that of spontaneous ventilation (SV) and controlled mechanical ventilation (CMV) without ARM or PEEP on early postoperative arterial oxygenation in anaesthetized healthy dogs. STUDY DESIGN: Prospective, randomized, nonblinded clinical study. ANIMALS: A total of 32 healthy client-owned dogs undergoing surgery in dorsal recumbency. METHODS: Dogs were ventilated intraoperatively (inspired oxygen fraction: 0.5) with one of the following strategies: SV, CMV alone, and CMV with PEEPmaxCrs+2 following a single ARM (ARM1) or two ARMs (ARM2, the second ARM at the end of surgery). Arterial blood gas analyses were performed before starting the ventilatory strategy, at the end of surgery, and at 5, 10, 15, 30 and 60 minutes after extubation while breathing room air. Data were analysed using Kruskal-Wallis and Friedman tests (p < 0.050). RESULTS: At any time point after extubation, PaO2 was not significantly different between groups. At 5 minutes after extubation, PaO2 was 95.1 (78.1-104.0), 93.8 (88.3-104.0), 96.9 (86.6-115.0) and 89.1 (87.6-102.0) mmHg in the SV, CMV, ARM1 and ARM2 groups, respectively. PaO2 decreased at 30 minutes after extubation in the CMV, ARM1 and ARM2 groups (p < 0.050), but it did not decrease after 30 minutes in the SV group. Moderate hypoxaemia (PaO2, 60-80 mmHg) was observed in one dog in the ARM1 group and two dogs each in the SV and ARM2 groups. CONCLUSIONS AND CLINICAL RELEVANCE: Intraoperative ARMs, followed by PEEPmaxCrs+2, did not improve early postoperative arterial oxygenation compared with SV or CMV alone in healthy anaesthetized dogs. Therefore, this ventilatory strategy might not be clinically advantageous for improving postoperative arterial oxygenation in healthy dogs undergoing surgery when positioned in dorsal recumbency.

Effect of recumbency and body condition score on open-lung positive end-expiratory pressure and respiratory system compliance following a stepwise lung recruitment manoeuvre in healthy dogs during general anaesthesia.

The aim was to assess the effects of recumbency and body condition score (BCS) on open-lung positive end-expiratory pressure (OL-PEEP) and quasistatic respiratory system compliance (Crs) following stepwise lung recruitment manoeuvre (RM) in healthy dogs under general anaesthesia. Thirty-four dogs were anaesthetised and mechanically ventilated (tidal volume of 10 mL/kg) without PEEP for 1 min (baseline). A stepwise RM was then performed and the individual OL-PEEP was subsequently applied. The Crs was registered at baseline and every 10-min for 50 min after RM. Dogs were classified into either dorsal or lateral recumbency groups, and as normal (score 4-5/9) or high (≥6/9) BCS groups. The OL-PEEP was higher in lateral than in dorsal recumbency (P = .002), but differences were not observed between normal and high BCS (P = .865). The Crs was increased from baseline at all time points after RM in all groups. The Crs did not differ between dorsally and laterally recumbent dogs at any time point. However, the baseline Crs was significantly lower in dogs with a high BCS than in those with a normal BCS (P < .001); therefore, the absolute change from baseline was considered when comparing Crs after the RM and it was similar in both BCS groups. In conclusion, in anaesthetised healthy dogs the OL-PEEP following RM was lower when dogs were positioned in dorsal than in lateral recumbency. The Crs after RM remained unchanged regardless of the dogs' recumbency. A stepwise RM followed by OL-PEEP could compensate for the potential negative impact of moderately increased BCS on Crs.

Efficacy of the Parasympathetic Tone Activity monitor to assess nociception in healthy dogs anaesthetized with propofol and sevoflurane.

OBJECTIVE: To compare a Parasympathetic Tone Activity (PTA) monitor with cardiovascular changes in invasive mean arterial pressure (IMAP) and heart rate (HR) when evaluating the response to nociceptive stimuli in anaesthetized dogs. STUDY DESIGN: Prospective experimental study. ANIMALS: A group of nine (seven male and two female) adult Beagle dogs weighing 13.4 ± 1.5 kg (mean ± standard deviation). METHODS: Anaesthesia was induced with propofol and maintained with sevoflurane in oxygen. Electrical stimuli of different nociceptive intensities were applied for 30 seconds. Stimuli were classified in each patient according to the response obtained (relevant change ≥ 20%) as low (no response), medium (PTA only) or high (PTA and IMAP/HR). Immediate and averaged values of PTA, IMAP and HR were recorded every second from 60 seconds before to 120 seconds after application of the nociceptive stimulus. Time to nociceptive response and peak response were evaluated with analysis of variance and t test. RESULTS: Immediate PTA baseline values did not differ significantly before application of the low, medium and high stimuli (73 ± 15, p = 0.966). Immediate PTA response was observed with the medium stimulus at 33 ± 7 seconds with a maximum decrease of 57 ± 13% at 69 ± 5 seconds. With the high stimulus, the immediate PTA response was of a similar magnitude to the medium stimulus with a response at 28 ± 7 seconds (p = 0.221) and a maximum decrease of 68 ± 15% (p = 0.115) at 72 ± 7 seconds (p = 0.436). The cardiovascular change occurred (22 ± 8 seconds) prior to the immediate PTA response (p = 0.032). CONCLUSIONS AND CLINICAL RELEVANCE: The PTA monitor detected nociceptive stimuli at lower intensities than those eliciting cardiovascular changes. However, nociceptive stimuli of higher intensities provoked cardiovascular changes that occurred before a PTA response was observed.

Comparative effects of open-lung positive end-expiratory pressure (PEEP) and fixed PEEP on respiratory system compliance in the isoflurane anaesthetised healthy dog.

This study was performed to assess the effects of open-lung positive end-expiratory pressure (OL-PEEP) following stepwise recruitment manoeuvre (RM) and those of a fixed PEEP of 5 cm H2O without previous RM on respiratory system compliance (Crs) and selected cardiovascular variables in healthy dogs under general anaesthesia. Forty-five healthy client-owned dogs undergoing surgery were anaesthetised and mechanically ventilated (tidal volume, VT = 10-12 mL/kg; PEEP = 0 cm H2O) for 1 min (baseline) and randomly allocated into zero positive end-expiratory pressure (ZEEP), PEEP (5 cm H2O) and OL-PEEP treatment groups. In the OL-PEEP group, a stepwise RM was performed and the individual OL-PEEP was subsequently applied. The Crs, heart rate (HR) and non-invasive mean arterial pressure (NIMAP) were registered at baseline and then every 10 min during 60 min. In the ZEEP group, Crs decreased from baseline. In the PEEP group, Crs was not different from either baseline or ZEEP group values. In the OL-PEEP group, Crs was higher than both baseline and ZEEP group values at all time points as well as of those in the PEEP group during at least 20 min after RM. There were no differences for HR and NIMAP between groups. A clinically relevant hypotension following RM was observed in 40% of dogs. Therefore, an individually set OL-PEEP following stepwise RM improved Crs in anaesthetised healthy dogs, although transient but clinically relevant hypotension was observed during RM in some dogs. Fixed PEEP of 5 cm H2O without previous RM did not improve Crs, although it prevented it from decreasing.

Can the intake of antiparasitic secondary metabolites explain the low prevalence of hemoparasites among wild Psittaciformes?

BACKGROUND: Parasites can exert selection pressure on their hosts through effects on survival, on reproductive success, on sexually selected ornament, with important ecological and evolutionary consequences, such as changes in population viability. Consequently, hemoparasites have become the focus of recent avian studies. Infection varies significantly among taxa. Various factors might explain the differences in infection among taxa, including habitat, climate, host density, the presence of vectors, life history and immune defence. Feeding behaviour can also be relevant both through increased exposure to vectors and consumption of secondary metabolites with preventative or therapeutic effects that can reduce parasite load. However, the latter has been little investigated. Psittaciformes (parrots and cockatoos) are a good model to investigate these topics, as they are known to use biological control against ectoparasites and to feed on toxic food. We investigated the presence of avian malaria parasites (Plasmodium), intracellular haemosporidians (Haemoproteus, Leucocytozoon), unicellular flagellate protozoans (Trypanosoma) and microfilariae in 19 Psittaciformes species from a range of habitats in the Indo-Malayan, Australasian and Neotropical regions. We gathered additional data on hemoparasites in wild Psittaciformes from the literature. We considered factors that may control the presence of hemoparasites in the Psittaciformes, compiling information on diet, habitat, and climate. Furthermore, we investigated the role of diet in providing antiparasitic secondary metabolites that could be used as self-medication to reduce parasite load. RESULTS: We found hemoparasites in only two of 19 species sampled. Among them, all species that consume at least one food item known for its secondary metabolites with antimalarial, trypanocidal or general antiparasitic properties, were free from hemoparasites. In contrast, the infected parrots do not consume food items with antimalarial or even general antiparasitic properties. We found that the two infected species in this study consumed omnivorous diets. When we combined our data with data from studies previously investigating blood parasites in wild parrots, the positive relationship between omnivorous diets and hemoparasite infestation was confirmed. Individuals from open habitats were less infected than those from forests. CONCLUSIONS: The consumption of food items known for their secondary metabolites with antimalarial, trypanocidal or general antiparasitic properties, as well as the higher proportion of infected species among omnivorous parrots, could explain the low prevalence of hemoparasites reported in many vertebrates.

Comparison of gizzard and intestinal microbiota of wild neotropical birds.

Gut bacterial communities have been shown to be influenced by diet, host phylogeny and anatomy, but most of these studies have been done in captive animals. Here we compare the bacterial communities in the digestive tract of wild birds. We characterized the gizzard and intestinal microbiota among 8 wild Neotropical bird species, granivorous or frugivorous species of the orders Columbiformes and Passeriformes. We sequenced the V4 region of the 16S rRNA gene in 94 collected samples from 32 wild birds from 5 localities, and compared bacterial communities by foraging guild, organ, locality and bird taxonomy. 16S rRNA gene-based sequencing data were examined using QIIME with linear discriminant analysis effect size (LEfSe) and metabolic pathways were predicted using PICRUSt algorism. We identified 8 bacterial phyla, dominated by Firmicutes, Actinobacteria and Proteobacteria. Beta diversity analyses indicated significant separation of gut communities by bird orders (Columbiformes vs. Passerifomes) and between bird species (p<0.01). In lower intestine, PICRUSt shows a predominance of carbohydrate metabolism in granivorous birds and xenobiotics biodegradation pathways in frugivorous birds. Gizzard microbiota was significantly richer in granivorous, in relation to frugivorous birds (Chao 1; non-parametric t-test, p<0.05), suggesting a microbial gizzard function, beyond grinding food. The results suggest that the most important factor separating the bacterial community structure was bird taxonomy, followed by foraging guild. However, variation between localities is also likely to be important, but this could not been assessed with our study design.

Occurrence and virulence properties of Vibrio and Salinivibrio isolates from tropical lagoons of the southern Caribbean Sea.

The Vibrionaceae are Gram-negative bacteria present in marine and estuarine environments worldwide, including several species known as important pathogens to humans and aquatic organisms. The aim of this research was to investigate the occurrence and virulence properties of Vibrio and Salinivibrio isolated from lagoons at Cuare Wildlife Refuge and Margarita Island in the southern Caribbean Sea. Water, plankton and oyster samples were collected during October 2011 and March 2012 and examined by specific PCR and culture methods. Vibrio genus DNA was detected in 95% of samples, while the intergenic spacer region (ISR) of Vibrio cholerae and the genes that code for the thermolabile direct haemolysin (tl) of Vibrio parahaemolyticus and the haemolysin/cytolysin (vvhA) of Vibrio vulnificus were absent or amplified in low proportions (23, 5, and 0%, respectively). Nine isolates from water and plankton were confirmed as Vibrio or Salinivibrio by phenotypic tests, 16S rRNA gene sequencing and phylogenetic analysis. All the isolates presented similar patterns of virulence factors, in which the genes ctxA (encoding for cholera toxin), tl and vvhA were lacking, whereas seven isolates displayed antibiotic resistance against ampicillin and cephalosporins. The 16S rRNA phylogenetic analysis showed the clustering of Vibrio isolates in three main clades: the plankton isolate from Cuare Wildlife Refuge formed a group with V. cholerae and Vibrio mimicus while the Margarita isolates clustered with sequences from the harveyi clade and Salinivibrio. This is the first time that Salinivibrio species are reported in tropical lagoons of the Caribbean Sea with antibiotic resistance.

Prevalence and Distribution of Vibrio spp. in Wild Aquatic Birds of the Southern Caribbean Sea, Venezuela, 2011-12.

Vibrio spp. are associated with waterbirds mainly in temperate latitudes. We evaluated the prevalence and distribution of Vibrio spp. from fecal samples of resident and migratory aquatic birds collected during October 2011 and March 2012 at two coastal sites in the tropical southern Caribbean Sea. We amplified DNA by PCR in 40% of samples, resulting in 47% and 36% estimated prevalence for resident and migratory birds in Cuare Wildlife Refuge, and 33% and 44% in Margarita Island, respectively. We found nontoxigenic Vibrio cholerae in Cuare Wildlife Refuge with a higher prevalence in resident birds (18%). Our PCR results for Vibrio and V. cholerae were not significantly different between sites or bird migratory status. The 16S rRNA phylogenetic analysis sequences from fecal samples from Cuare Wildlife Refuge were highly similar to V. cholerae and Vibrio vulnificus , whereas sequences from Margarita Island samples formed clusters with species related to the Harveyi clade. Our findings indicate that several species of Vibrio are common in aquatic birds along the southern Caribbean Sea and contribute to our understanding of the role of birds as possible reservoirs of potentially pathogenic bacteria.

BAP1-deficient and VE1-negative atypical Spitz tumor.

Atypical Spitz tumor with loss of BAP1 or Wiesner nevus is a peculiar variant of intradermal spitzoid melanocytic neoplasm composed of epithelioid melanocytes with a sheet-like growth pattern, abundant infiltrating lymphocytes and rare or absent mitotic activity. This subset of atypical spitzoid tumors is characterized by the BRAF(V600E) mutation and loss of BAP1 expression. Recognition of these lesions is important because they can be a marker for a hereditary BAP1-associated cancer syndrome. We present an unusual case of sporadic Wiesner nevus that had typical histopathologic features and a BAP1 but not a BRAF mutation. The biological significance of Wiesner nevus is controversial, and little is known about prognosis, particularly in atypical cases like this one.

Insights from quantum chemistry into piperazine-based ionic liquids and their behavior with regard to CO2.

The short-range properties of alkylpiperazine ionic liquids paired with propionate and lactate anions were analyzed and their affinity for CO2 molecules studied using density functional theory. Anion-cation interactions led to the development of strong intermolecular hydrogen bonding through the cation amine position, as confirmed through variations in structural and vibrational properties upon pair formation. Topological analysis via the atoms-in-molecules approach revealed the development of intense bond and ring critical points in the intermolecular regions, which is in agreement with charge transfer from lone pairs in anion oxygen atoms of carboxylate groups through antibonding orbitals in cation amine groups. Such anion-cation interactions are weakly dependent on cation alkyl chain length but are remarkably affected by the presence of an anion hydroxyl group. Interactions with CO2 molecules are stronger for anions than for cations, especially for propionate anions, and are also affected strongly by the anion hydroxyl group.

Low occurrence of Helicobacter DNA in tropical wild birds, Venezuela.

Enteric Helicobacter species (Helicobacter pullorum, Helicobacter pametensis, Helicobacter canadensis, Helicobacter anseris, and Helicobacter brantae) have been found in birds from temperate latitudes. We evaluated the occurrence of Helicobacter spp. in terrestrial wild birds from Venezuela. A fragment of 16S rRNA gene was amplified by PCR with Helicobacter genus-specific primers. Helicobacter spp. were detected in four of 80 fecal and in three of 42 intestinal tissue samples. Analyses of 16S and 23S rRNA gene sequences confirm for the first time the presence of Helicobacter in tropical terrestrial wild birds. However, the occurrence of Helicobacter was low, suggesting these bacteria may be uncommon in the populations we studied.